Insects and Disease

Neonatal care has been one of the most rapidly advancing parts of paediatrics for at least 15 years. Several books have appeared in the last few years in response to an obvious need for practical guidance on the management of the sick newborn baby. This book fulfils two of the main requirements for such a worrk to be successful-it is firmly rooted in the physiological principles on which modem neonatal care depends, and it is specific and detailed in its practical advice. The method of presentation is unusual and interesting. Most of the chapters start with straightforward text, but this is followed by a series of questions and answers, and a series of case problems with multiple choice questions. The reader can thus test himself as he goes along and, more importantly, can learn new facts and ideas about neonatal care. The book is thus something of a cross between a conventional (but practically-orientated) textbook and that rather unattractive production, the programmed text. The compromise seems highly successful, being lively and interesting, and it will certainly provide a useful learning experience for trainees in the subject, as well as their seniors. The neonatal resident, waiting on the ward to do an exchange transfusion, could dip into the question and answer sections with enjoyment when a straigh-forward text might simply send, him to sleep. A further lively feature of the book is the frequent inclusion of conmments on the text by other experts. That these sometimes contradict what has just been sa'd may sound confusing; in fact it is an effective way of indicating the uncertain and controversial parts of neonatal management. The printed word can easily take on a spurious air of authority, and the notes of dissent are saluwary. Altogether this is a book of interest not only to present and would-be neonatologists, but also to anvone interested in medical teaching and learning. It need only be added that the explanations and advice are generally clear, thoughtful, and reasonable, and that it is particularly good to find a long, well argued, and very practical chapter on the care of the mother and the emotional aspects of neonatal problems. R. J. ROBINSON

Neonatal care has been one of the most rapidly advancing parts of paediatrics for at least 15 years. Several books have appeared in the last few years in response to an obvious need for practical guidance on the management of the sick newborn baby. This book fulfils two of the main requirements for such a worrk to be successful-it is firmly rooted in the physiological principles on which modem neonatal care depends, and it is specific and detailed in its practical advice.
The method of presentation is unusual and interesting. Most of the chapters start with straightforward text, but this is followed by a series of questions and answers, and a series of case problems with multiple choice questions. The reader can thus test himself as he goes along and, more importantly, can learn new facts and ideas about neonatal care. The book is thus something of a cross between a conventional (but practically-orientated) textbook and that rather unattractive production, the programmed text. The compromise seems highly successful, being lively and interesting, and it will certainly provide a useful learning experience for trainees in the subject, as well as their seniors. The neonatal resident, waiting on the ward to do an exchange transfusion, could dip into the question and answer sections with enjoyment when a straigh-forward text might simply send, him to sleep.
A further lively feature of the book is the frequent inclusion of conmments on the text by other experts. That these sometimes contradict what has just been sa'd may sound confusing; in fact it is an effective way of indicating the uncertain and controversial parts of neonatal management. The printed word can easily take on a spurious air of authority, and the notes of dissent are saluwary. Altogether this is a book of interest not only to present and would-be neonatologists, but also to anvone interested in medical teaching and learning. It need only be added that the explanations and advice are generally clear, thoughtful, and reasonable, and that it is particularly good to find a long, well argued, and very practical chapter on the care of the mother and the emotional aspects of neonatal problems. This is an interim report on the developmental progress of a sample of 782 children (of whom 50 were controls), born in two hospitals in Hong Kong in 1967. The survey babies, who weighed at least 5 lib (2-27 kg) and had no known abnormalities, were followed up at monthly intervals by a multiprofessional team including paediatricians, nurses and clerical workers, an anthropologist, and a statistician. The controls were seen at six-monthly intervals. Originally it was planned to follow the children from birth to 5 years, but funds are now available to follow up to 8 years.
The authors decided to publish this interim report of progress up to the age of 3 years because the initial findings con-sistently revealed a period of malnutrition between 4 and 24 months-that is, between weaning and ability to cope with adult diet --with definite retardation in physical growth and increased incidence of illness. For these reasons they considered the institution of preventive measures was required as a matter of urgency.
Particulars of mothers' pregnancy and labour, their home conditions, and family structure were recorded, together with infants' medical history, care, feeding, and weaning. Growth developmental milestones were assessed on a purpose-designed scale, which included tests for motor abilities, coordination and performance, general intelligence, language, and personal-social behaviour. Visual and auditory competence were only roughly assessed, which seems a pity, as visual defects are reported to be particularly conmon in Chinese school children. The children co-operated well in tests until about 12 months, but thereafter until admission to kindergarten at about 3 years they were apathetic and unforthcoming. Gross motor abilities, except stair-dlimbing in those who lived in high flats, were delayed, manipulations were superior, but little interest was shown in pictures and spoken language was difficult to elicit. Though general improvement in growth patterns occurred at about 24 months it remains to be seen whether retardation in growth at a tine when the central nervous system is still rapidly developing and particularly vulnerable has permanent ill-effects.
Recommendations regarding provision of improved weaning diets, especially milk subsidies, reduction in overcrowding, and better facilities for access to open spaces are given. The book is an admirable report of an exercise in community paediatrics which merits careful study. Illustrated by a number of excellent photographs, it is well produced, referenced, and indexed. This splendid book deals primarily with the identification of the arthropods, and contains many keys (to families, or genera, or, in a few instances, to species). It is embellished by 210 exquisite line drawings of the arthropods or their organs, with seven maps of disease distribution, and 12 half-tone plates of photographs or coloured drawings. Some of the classical drawings by Terzi are included, which are a joy to see, and many, equally exact and of equal artistic merit, by artists named in the editor's preface.
The early part of the book relates to the general structure of insects, to classification and nomenclature, to geographical regions, and to methodcs of collection and preservation. The 19 chapters, by different contributors, vary in content. For instance, the chapter on mosquitoes (P. F. Mattingly) bears only a short note on disease relations and bionomics, whereas the chapter on Simuliidae (R. W. Crosskey) contains a long and detailed description of the medical importance of these flies as pests and transmitters of Onchocerca. The relationshWps of Phlebotomidae, Glossinidae, and Muscidae to disease are discussed, but more briefly.
All the relevant arthropods are here. Those of minor medical importance receive only short notices, but the major groups (Muscidae, Siphonaptera, Hemiptera) receive full treatment. There is an unusual short chapter on forensic entomology, a long one on eggs and larvae of flies, and a short one on insects and hygiene. Chapter 19 by P. F. Mattingly, R. W. Crosskey, and K. G. V. Smith contains a long table of 24 pages in which the species of the various classes, orders, families, and genera are named, together with the organisms they transmit and the hosts and geographical areas in which there is known association between the vectors, the pathogens, and man. This is a mot useful source for quick reference. There is an index to authors cited and an adequate subject index.
Apart from taxonomy, the book has a strong affinity with tropical medicine, not because arthropods are particularly common in hot countries (there are plenty of mosquitoes and Simulium in Canada), but because the ecological requirements of pathogen, vector, and host meet more consistently and dangerously (for man) in the tropics than elsewhere.
The text is lucid, and contains a lot of out-of-the-way information not usually found in books of medical entomology. This is a book for teachers and advanced students; it is a reference book which should be in every library or department in which tropical medicine is studied.